SSG 03.10.18 Scheduled Clinic Booking  Form
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Email *
Clinic Details
TIME:  1.30pm to 4.30pm, 3rd October 2018
LOCATION: R321, RCSI, 26 York Street
GENERAL INFORMATION: www.rcsi.ie/dscrole 
CONTACT US: data@rcsi.ie
Your Contact Details:
Name: *
RCSI Department/School/Faculty: *
RCSI Principal Investigator, if applicable:
Have you previously attended a scheduled clinic appointment? *
Appointment Time
What time will you attend? Please select one of the currently available appointment times below. *
Query Description
What are you seeking assistance with? *
Required
Please provide a brief summary of your query: *
A copy of your responses will be emailed to the address you provided.
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